Hung Anna, Shapiro Abigail, Weidenbacher Hollis J, Brown Adrian D, Thomas Greeshma M, Lawrence Ellen B, Van Loon Katherine, Berkowitz Theodore S, Steinhauser Karen, Smith Valerie A, Kullgren Jeffrey T, Fagerlin Angela, Reed Shelby D, Maciejewski Matthew L, Thorpe Carolyn T
Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Medical Center, Durham, NC, USA.
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
J Gen Intern Med. 2025 May 6. doi: 10.1007/s11606-025-09576-6.
Veterans' dual use of VA and Medicare Part D to fill diabetes medications is common and has advantages as well as disadvantages.
To understand the factors Veterans and their care partners consider when choosing whether to fill their diabetes medications through VA only, Part D only, or both, as well as their medication acquisition challenges and informational needs.
Semi-structured interviews between April and September 2023. Transcripts were analyzed via descriptive content analysis with deductive and inductive approaches.
In total, 24 Veterans and 12 care partners.
Drivers of choice, medication acquisition challenges, and informational needs that Veterans and care partners report when choosing where to fill their diabetes medications.
Cost, followed by formulary access, were main drivers of where Veterans and their care partners chose to fill their diabetes medications. Drive time, convenience, and preference for a particular provider were also considered, and care partners expressed a desire to streamline all of a Veteran's care to VA or Medicare for convenience and time savings. Veterans and care partners had mixed experiences with dual use, with some expressing frustration related to communication challenges between providers and incompatibilities between different health systems. Health-related risks associated with dual use were rarely mentioned. Veteran and care partner informational needs included relative costs and availability of medications on the formularies, and there was a preference to have direct access to information alongside telephone-based pharmacy support.
Cost and then medication access as well as drive time, convenience, and preference for a particular provider influenced Veteran and care partner choices on where to fill medications. Care partners often preferred one system. Differences and incompatibilities between VA and Medicare at times led to frustration and challenges filling medications. Information and support are needed to help Veterans and their care partners.
退伍军人同时使用退伍军人事务部（VA）和医疗保险D部分来获取糖尿病药物的情况很常见，且有其利弊。
了解退伍军人及其护理伙伴在选择仅通过VA、仅通过D部分还是同时通过两者来获取糖尿病药物时所考虑的因素，以及他们在药物获取方面面临的挑战和信息需求。
2023年4月至9月进行半结构化访谈。通过描述性内容分析，采用演绎和归纳方法对访谈记录进行分析。
共有24名退伍军人和12名护理伙伴。
退伍军人和护理伙伴在选择何处获取糖尿病药物时报告的选择驱动因素、药物获取挑战和信息需求。
成本，其次是药品目录准入，是退伍军人及其护理伙伴选择何处获取糖尿病药物的主要驱动因素。驾驶时间、便利性以及对特定医疗机构的偏好也被纳入考虑，护理伙伴表示希望为方便和节省时间，将退伍军人的所有护理整合到VA或医疗保险中。退伍军人和护理伙伴在同时使用两种途径方面有不同的经历，一些人对提供者之间的沟通挑战以及不同医疗系统之间的不兼容性表示沮丧。很少有人提及同时使用两种途径带来的健康相关风险。退伍军人和护理伙伴的信息需求包括药品目录上药物的相对成本和可获得性，并且他们更倾向于在获得电话药房支持的同时能直接获取信息。
成本、药品获取以及驾驶时间、便利性和对特定提供者的偏好影响了退伍军人和护理伙伴在何处获取药物的选择。护理伙伴通常更喜欢一种系统。VA和医疗保险之间的差异和不兼容性有时会导致在获取药物时产生沮丧和挑战。需要提供信息和支持来帮助退伍军人及其护理伙伴。
